Search Results (343)

Background: A precise radiographic evaluation of adolescent idiopathic scoliosis (AIS) is essential for effective treatment planning and follow-up. The pelvic axial rotation (PAR) and horizontal balance of the pelvis are critical factors to consider throughout the treatment and monitoring of AIS. While some previous studies have examined spinal curvature in relation to PAR direction and the direction of the major curve (DMC) in AIS patients, this study aims to explore the relationship between scoliosis morphology, pelvic axial rotation (PAR), and the direction of the major curve in patients with adolescent idiopathic scoliosis. Methods: Radiographic images of 397 patients diagnosed with AIS between 2023 and 2024 at a Tertiary Referral Hospital were retrospectively evaluated. Morphological and morphometric measurements, including sex, Lenke and Risser classifications, lower leg discrepancy, Cobb angle, PAR direction, and major curvature direction, were performed. Results: The mean age of the 397 patients (246 female, 151 male) was 14.47 ± 2.29. There is no significant correlation between PAR and DMC (p = 0.919). No significant differences were found in terms of sex (p = 0.603). Regardless of the PAR direction, major curvature was more common on the left side (57.7%). Furthermore, a positive correlation was noted between the Cobb angle and LLD. Conclusions: Our study contributes to a growing body of literature questioning the deterministic role of PAR in AIS. While previous reports have emphasized the directional correlation between the pelvis and spinal curvature, our findings suggest that pelvic rotation may not be a reliable indicator of curve direction in all patients. This highlights the complexity of AIS biomechanics and underscores the need for individualized radiographic and clinical evaluation rather than a reliance on generalized compensatory models. Full article

Background/Objectives: Surgical treatment is generally recommended for adolescent idiopathic scoliosis (AIS) when the Cobb angle exceeds 50 degrees even after skeletal maturity or 40 degrees with remaining growth potential. However, limited evidence exists regarding the natural history of curves between 40 and 50 degrees during the late stage of skeletal growth. This study aimed to evaluate the curve progression in AIS patients with a curve between 40 and 50 degrees at Risser stage IV or V. Methods: The inclusion criteria were as follows: (1) AIS patients at the late stage of skeletal growth (Risser IV or V) and a (2) curve between 40 and 50 degrees, with a minimum follow-up of 5 years. Sex, age, the magnitude of the curve, the location of the apex, Risser stage, height, and weight were measured at the baseline and the final follow-up. Curve progression was defined as an increase in the Cobb angle of ≥5 degrees. Patients were also categorized based on whether their final Cobb angle was <50 or ≥50 degrees to evaluate additional risk factors. Results: A total of 97 patients were included, with a mean follow-up of 97 months. Their mean age was 14.6 years at the baseline and 22.6 years at the final follow-up. The mean Cobb angle increased from 42.6 to 45.1 degrees, with a mean change of 2.7 degrees and an annual progression rate of 0.35 degrees. Curve progression was observed in 38 patients (39.2%), and 24 patients (24.7%) reached a final Cobb angle ≥ 50 degrees. Younger age (p = 0.004) and Risser stage IV (p = 0.014) were significantly associated with curve progression. In patients with a final Cobb angle ≥ 50 degrees, Risser stage IV (p = 0.050) and a larger baseline curve magnitude (p = 0.045) were also significant risk factors. Conclusions: In AIS patients at the late stage of skeletal growth, 39.2% experienced significant curve progression. A younger age and Risser stage IV were identified as risk factors for curve progression. A larger baseline curve magnitude and Risser stage IV were also associated with a final Cobb angle ≥ 50 degrees. Full article

Background and Objectives: General-purpose multimodal large language models (LLMs) are increasingly used for medical image interpretation despite lacking clinical validation. This study evaluates the diagnostic reliability of ChatGPT-4o and Claude 2 in photographic assessment of adolescent idiopathic scoliosis (AIS) against radiological standards. This study examines two critical questions: whether families can derive reliable preliminary assessments from LLMs through analysis of clinical photographs and whether LLMs exhibit cognitive fidelity in their visuospatial reasoning capabilities for AIS assessment. Materials and Methods: A prospective diagnostic accuracy study (STARD-compliant) analyzed 97 adolescents (74 with AIS and 23 with postural asymmetry). Standardized clinical photographs (nine views/patient) were assessed by two LLMs and two orthopedic residents against reference radiological measurements. Primary outcomes included diagnostic accuracy (sensitivity/specificity), Cobb angle concordance (Lin’s CCC), inter-rater reliability (Cohen’s κ), and measurement agreement (Bland–Altman LoA). Results: The LLMs exhibited hazardous diagnostic inaccuracy: ChatGPT misclassified all non-AIS cases (specificity 0% [95% CI: 0.0–14.8]), while Claude 2 generated 78.3% false positives. Systematic measurement errors exceeded clinical tolerance: ChatGPT overestimated thoracic curves by +10.74° (LoA: −21.45° to +42.92°), exceeding tolerance by >800%. Both LLMs showed inverse biomechanical concordance in thoracolumbar curves (CCC ≤ −0.106). Inter-rater reliability fell below random chance (ChatGPT κ = −0.039). Universal proportional bias (slopes ≈ −1.0) caused severe curve underestimation (e.g., 10–15° error for 50° deformities). Human evaluators demonstrated superior bias control (0.3–2.8° vs. 2.6–10.7°) but suboptimal specificity (21.7–26.1%) and hazardous lumbar concordance (CCC: −0.123). Conclusions: General-purpose LLMs demonstrate clinically unacceptable inaccuracy in photographic AIS assessment, contraindicating clinical deployment. Catastrophic false positives, systematic measurement errors exceeding tolerance by 480–1074%, and inverse diagnostic concordance necessitate urgent regulatory safeguards under frameworks like the EU AI Act. Neither LLMs nor photographic human assessment achieve reliability thresholds for standalone screening, mandating domain-specific algorithm development and integration of 3D modalities. Full article

Background/Objectives: This study aimed to examine the occurrence and risk factors for proximal junctional kyphosis (PJK) in relation to preoperative sagittal alignment, particularly the shape of thoracolumbar kyphosis (TLK) and the proportion of lumbar lordosis. Methods: We recruited 38 consecutive patients with adolescent idiopathic scoliosis (AIS) who underwent isolated posterior fusion. Participants were categorized according to the presence or absence of PJK at 1 year postoperatively (PJK+ or non-PJK) and by preoperative TLK status (positive or negative; pre-TLK+ or pre-TLK, respectively). We compared spinal parameters preoperatively, immediately postoperatively, and at 1 year postoperatively between groups. Results: Among the 38 participants, PJK occurred in 21 patients (55.3%). The PJK group had significantly larger preoperative TLK and LDI values and decreased postoperative TLK and LDI. Simple linear regression revealed a moderate positive correlation between ΔPJA and preoperative TLK as well as a fair positive correlation between ΔPJA and changes in TLK and LDI. The prevalence of PJK was high (83.3%) in the pre-TLK+ group (24 patients), and preoperative LDI was significantly larger compared with the pre-TLK group. However, TLK and LDI were significantly decreased after surgery in the pre-TLK+ group. Conclusions: Patients with Lenke-5C curvature who exhibit positive preoperative TLK are at a very high risk of developing PJK after isolated posterior surgery. Preoperative sagittal alignment should be considered when planning the extent of sagittal correction. Full article

This study examined the relationship between spinal morphological changes and gait characteristics in patients with adolescent idiopathic scoliosis (AIS) using inertial measurement unit (IMU) analysis. Twenty-three female patients with AIS scheduled for corrective surgery underwent a preoperative gait analysis using an IMU positioned at the third lumbar vertebra. Gait stability indicators were calculated, including root mean square (RMS) values for mediolateral (RMSx), anteroposterior, and vertical components. Peak mediolateral components in four coronal plane quadrants were also analyzed. Relationships with the main thoracic (MT) curve, the thoracolumbar (TL) curve, and thoracic kyphosis (TK) were assessed using Spearman’s rank correlation. The MT curve is positively correlated with RMSx, whereas TK exhibited a negative correlation. Gait symmetry analysis revealed a positive correlation between the MT curve and peak mediolateral trunk acceleration in the second (left upper) quadrant, and negative correlations for TK in the first (right upper) and fourth (right lower) quadrants. Patients with AIS who have right-convex MT curves demonstrated leftward center-of-gravity shifts, although reduced TK limited this compensatory mechanism. These findings may inform the development of rehabilitation strategies for AIS. Full article

Background: The aim of this study was to assess pedicle screw (PS) accuracy and identify perforation patterns using computed tomography (CT) navigation in adolescent idiopathic scoliosis (AIS) surgery. Methods: A total of 107 AIS patients were retrospectively reviewed. Preoperative CT navigation was used in 48 patients (853 screws), and intraoperative CT with a second 3D scan was used in 59 patients (1059 screws). Postoperative CT images were analyzed using the Rampersaud grading system. Results: Overall PS accuracy (grade A + B) was significantly higher in the intraoperative CT group than the preoperative group (97% vs. 95%, p = 0.008). In Lenke type 1 cases, accuracy was also higher in the intraoperative group (97.8% vs. 95.1%, p = 0.014). Grade D perforations were most frequent on the concave side of the proximal thoracic (PT) zone in both groups. Ten screws were re-inserted during surgery in the intraoperative group based on findings from the second 3D scan. Conclusions: The concave PT zone is a common site for PS misplacement. Intraoperative CT navigation with a second 3D scan enhances PS accuracy compared with preoperative CT navigation. Full article

Background/Objectives: This is a study of adolescents with idiopathic scoliosis (IS), treated by the Functional Individual Therapy of Scoliosis (FITS) method. The hypothesis was that active parental involvement in the treatment process enhances the outcomes of therapy. Materials and Methods: A total of 208 adolescent girls with IS were examined and divided into two groups. Only in Group I were the parents present. Trunk morphology before and after was evaluated by measuring change of the Anterior Trunk Symmetry Index (ATSI), Posterior Trunk Symmetry Index (POTSI), Posterior Trunk Symmetry Index in Correction (POTSI COR), and the angle of trunk rotation (ATR). Results: Statistically significant improvements in ATSI values were observed in both groups (Group I: p < 0.001; Group II: p = 0.001). POTSI values showed improvement only in Group I (p < 0.001). Similarly, POTSI COR values improved significantly in Group I (p < 0.001). ATR improved significantly better in Group I. Conclusion and Significance: Children with IS who underwent specific physiotherapy demonstrated better outcomes when their parents actively participated in the therapy. Full article

Background/Objectives: Adolescent Idiopathic Scoliosis (AIS) is a lateral curvature of the spine combined with rotation and associated postural changes. Curves are classified according to direction and the spinal region, with right thoracic curves being a common presentation. Curve magnitude is measured using Cobb angles on radiographs and is used to monitor curve progression, with one of the main aims of treatment being prevention of progression to surgical levels. Treatment options may include observation, physiotherapeutic scoliosis-specific exercises (PSSE), thoracolumbosacral orthotic (TLSO) bracing, or surgery and are dependent on curve magnitude, risk of progression, and patient goals. Methods: This case series includes five patients (four female and one male, mean age of 14.8 y) who received previous non-surgical treatment without success and had severe right thoracic AIS with an average Cobb angle measurement of 53.4°, involving spinal curve magnitudes that warrant surgical recommendation. Results: These patients’ curves were successfully reduced to nonsurgical levels utilizing a non-surgical, multimodal treatment approach combining 3D corrective TLSO bracing using the ScoliBrace^®, PSSEs, and spinal rehabilitation over an average of 37.0 months. The average Cobb angle reduced from 53.4° to 29.6° (44.6% reduction) after being weaned off treatment. Conclusions: This series has shown successful, clinically significant improvement in Cobb angle and trunk symmetry in five patients with severe AIS using a non-surgical, multimodal approach combining 3D corrective TLSO bracing using the ScoliBrace^® and spinal rehabilitation procedures. Further investigation into this multimodal non-surgical approach for children, parents, and healthcare providers and policymakers seeking an alternative to surgical intervention for AIS is warranted. Full article

Background and Objectives: Surgical site infections (SSIs) significantly impact pediatric spinal deformity surgery. Considering the increased risk of Gram-negative infections in neuromuscular scoliosis (NMS), broader antibiotic coverage could be advantageous. Some studies suggest extending this approach to all scoliosis etiologies to reduce SSI rates. This study evaluates whether a dual antibiotic prophylaxis with cephalosporin and aminoglycoside reduces SSI incidence within 90 days postsurgery in adolescent idiopathic scoliosis (AIS), NMS, and syndromic scoliosis (SS) patients. Materials and Methods: This study included pediatric patients with AIS, NMS, or SS curves, treated with posterior spinal fusion between January 2019 and December 2022, with a minimum two-year follow-up. The primary outcome was early SSI incidence and its correlation with dual antibiotic prophylaxis in pediatric scoliosis surgery. Secondary outcomes included operative data, blood loss, hemoglobin levels, hospital stay, complications, pelvic fixation, and radiographic correction and how these factors could be identified as potential risk factors for SSIs. Descriptive and inferential statistics were used to analyze antibiotic regimen, SSI risk, and perioperative variables using chi-square, Mann–Whitney U, ANOVA, and Cox regression. Significance was set at p < 0.05. Results: The study included 296 patients: 222 with AIS, 46 with NMS, and 28 with SS. Ninety days postsurgery, SSI rates were 1.2% in AIS (0.8% deep, 0.4% superficial), 6.5% in NMS (all superficial), and 3.5% in SS (all superficial). Deep SSIs in AIS were associated with methicillin-resistant Staphylococcus aureus (MRSA). None of the cases required implant removal. Univariate Cox regression did not reveal any statistically significant predictors for SSIs. However, older age at surgery showed a protective trend, while higher preoperative ASA scores seemed to be a negative prognostic factor (respectively p = 0.051 and p = 0.08). Conclusions: Dual antibiotic prophylaxis with cefazolin and amikacin was associated with a lower SSI rate after posterior spinal fusion for scoliosis, with no adverse events. Further studies are needed to refine dosage, timing, and duration. Full article

Background/Objectives: Morphological spinal alterations in adolescents, including idiopathic scoliosis (IS) and postural scoliotic attitudes (paramorphisms), may be associated with leg length discrepancy (LLD) and breast asymmetry (BA). This study aimed to assess the prevalence and characteristics of LLD and BA in adolescents with spinal paramorphisms and dysmorphisms (IS), and to explore associations between these asymmetries and spinal curve features. Methods: A cross-sectional observational study was conducted. Adolescents aged 10–18 years were included. LLD was measured clinically via direct tape measurement and, when necessary, ultrasound. BA was assessed via visual inspection. Spinal deformities were characterized via clinical and radiological examination. Results: Among the 44 participants, 26 (60%) had IS and 18 (40%) had postural scoliotic attitudes. LLD was present in 79.5% (mean 0.7 ± 0.6 cm; all mild). BA was observed in 14% of the sample. LLD was more frequent in IS (87%) than in postural scoliotic attitudes (72%). In lumbar postural curves, the shorter limb was consistently ipsilateral to the curve convexity. In IS, no consistent association was found between LLD and curve characteristics. BA was slightly more prevalent in IS (19%) than postural scoliotic attitudes (17%), with no consistent pattern relative to curve convexity. Conclusions: Mild LLD is common in adolescents with spinal asymmetries and reflects general population norms. While LLD may influence compensatory postural curves, it does not appear to affect IS curve patterns or severity. BA is more frequent in IS, but shows variable association with curve features. Considering LLD and BA prevalence in adolescents with spinal asymmetries routine assessment is warranted, though their impact on IS progression is limited. Full article

This report provides a concise selective representative overview of the predictor factors for progression in Idiopathic Scoliosis (IS). The Cobb angle method, rib hump deformity, imaging and advanced techniques for assessing skeletal maturity serve as key elements in evaluating prognostic factors for IS progression based on the patient’s age at diagnosis—particularly in Infantile Idiopathic Scoliosis (IIS), Juvenile Idiopathic Scoliosis (JIS), and Adolescent Idiopathic Scoliosis (AIS). The commonly used approaches for determining skeletal maturity include the assessment of the iliac apophysis and scoliosis curve deterioration, the Sanders skeletal maturity staging system, the distal radius and ulna (DRU) classification for predicting growth spurts and curve progression in IS, as well as the ossification of vertebral epiphyseal rings, the humeral head, and the calcaneal apophysis. Prognostic factors influencing IS progression are further discussed in relation to the patient’s age at onset—whether in infancy, childhood, or adolescence—as well as in both untreated and braced AIS patients. Additionally, the apical convex rib–vertebra angle in AIS is explored as an indicator of progression. Predictors for curve progression at skeletal maturity are outlined, along with various models for forecasting IS deterioration. Lastly, the Rib and Segmental Rib Index, a rib cage deformity parameter, is introduced as a predictor of scoliosis progression. In conclusion, this concise and selective overview of predictor factors for progression in IS highlights the current understanding of IS progression factors. It also introduces the Rib and Segmental Rib Index—a rib cage deformity parameter—as a predictor of IS progression. Full article

Background and Objectives: This retrospective cohort study compared selective thoracic fusion (STF) and non-STF for adolescent idiopathic scoliosis (AIS) Lenke 1B/1C curves. Although STF is considered an attractive option for patients with a compensatory lumbar curve, direct clinical comparisons between STF and non-STF remain limited. Materials and Methods: AIS patients (≥2 years follow-up) undergoing posterior spinal fusion were divided into STF (57 cases) and non-STF (21 cases) groups. The correction rates of their main thoracic (MT) and thoracolumbar/lumbar (TL/L) curves, coronal balance, and SRS-22r scores were statistically compared. Results: Two years after the operation, while MT curve correction and coronal balance showed no significant differences, TL/L curve correction was significantly higher in the non-STF group. In contrast, the STF group had a significantly higher SRS-22r function score, with comparable results for self-image and satisfaction. Conclusions: Both STF and non-STF present distinct characteristics that should be considered to optimize surgical decision-making. Full article

This opinion article refers to the “double rib contour sign” and to the rib index (DRCS and RI), to their reliability study results in the chest radiographs of a control group and to their validity study results. These two parameters were introduced by the first author in this report. The introduction of the Segmental Rib Index (SRI) and its relation to spinal deformity is also discussed. The RI has been confirmed to be a strong surrogate for scoliometric readings in idiopathic scoliosis (IS). The clinical applications of the RI are analyzed for the following: (a) the documentation of deformity; (b) the assessment of physiotherapy outcomes (PSSEs); (c) the documentation of the outcomes of brace treatment; (d) the documentation of the pre- and post-operative assessment of thoracic deformity correction in different types of instrumentation; (e) its usage in prognosticating accelerated deterioration in skeletally mature adolescent idiopathic scoliosis (AIS) curves of 40–50 degrees; and (f) its usage in the recognition of the proper rib level for thoracoplasty/costoplasty. The emerging etiological–scoliogenic implications from the use of the DRCS and RI are described. The rotation of the trunk and vertebral bodies as interrelated, but distinct parameters are finally analyzed. Full article

Background: Non-surgical management of adolescent idiopathic scoliosis (AIS) includes physiotherapeutic scoliosis-specific exercise (PSSE). Determining the efficacy of PSSE in AIS has been challenging as the clinical effect is closely linked to exercise compliance (a dose–response relationship), with home exercise programs (HEPs) showing a general trend for decreased participation over time. The existing literature reports contradictory definitions and parameters of appropriate PSSE compliance in AIS. As such, this scoping review is necessary for therapists to identify PSSE prescription consistency, enabling clear guidelines for improved PSSE compliance. Methods: A scoping review of the literature was conducted to synthesize original research from inception to November 2024 and reference lists were examined for studies reporting compliance, adherence, or motivational strategies for PSSE in AIS. Results: Fifteen articles with a focus on PSSE in AIS were included in this review. The results demonstrate that compliance (C) and adherence (A) are terms commonly used interchangeably, only half of the studies clearly define compliance and/or adherence, and some utilize motivational strategies; however, outcomes of compliance/adherence were often not reported in the Results section or reflected in the discussion of results. Conclusions: Compliance and/or adherence are inconsistently reported within studies and numerous variations exist in (1) the section of the paper it is mentioned, (2) whether the inclusion criteria hinged on patient compliance/adherence, and (3) whether motivational strategies were employed and outcomes reported. Notably, there was a lack of compliance or adherence reporting in Results and Discussion sections of papers. The definition of appropriate compliance and any effective motivational strategies to improve compliance to achieve the desired results for treatment of AIS remain undetermined. Full article

Background: The aim of the study was to assess the difference in hip adduction in extended joint position in girls with adolescent idiopathic scoliosis (AIS). Methods: The study group consisted of 69 girls aged 9 to 14 years. The observational cross-sectional study involved interview, the clinical examination (body weight measurement, measuring the body height in an upright position, assessment of the alignment of the spinous processes of the thoracic and lumbar vertebrae, assessment of the location of selected anatomical landmarks of the torso), physical examination in which the shape of the ridge surface was analyzed with the use of the photogrammetric method and the moiré effect projection and tests (test of adduction of both hips). Results: Significant differences were noted in the values of abduction for the left and right hip. In the studied group, the mean adduction angle for the left hip was 26.3° and only 19.2° for the right hip. The difference was statistically significant (p < 0.001). Similarly, significant relationships were noted by the authors with reference to values of the difference in abduction for both hips and the sizes of thoracic (p = 00012) and lumbar curvature (p < 0.0001). A significant relationship was also noted between the values of lumbar curvature and the size of adduction for the right hip (p < 0.0001). Conclusions: Abductive contracture of the right hip was noted in the examined girls with AIS. The degree of scoliotic deformity of the lumbar spine is related to the size of the abductive contracture of the right hip joint. Full article